Co-producing a ‘creative toolkit’ to support the mental health and wellbeing of palliative care professionals

Providing palliative and end of life care during the peaks of the COVID-19 pandemic had profound negative impacts on the mental health and wellbeing of healthcare workers.  Professionals reported anxiety, depression, burnout, post-traumatic stress disorder (PTSD), and moral distress and a lack of readily available mental health support (Couper et al., 2022; Maben et al., 2022; Watts et al., 2023).

This was the backdrop against which the Creative Toolkit project team – comprising palliative care practitioners, university lecturers, and nursing students – collaborated on the co-production of a ‘creative toolkit’ to support the mental health and wellbeing of healthcare workers.

Assembling an interdisciplinary team

Development of this creative toolkit intervention builds on a strong tradition of introducing the arts into medical contexts (e.g., Scott, 2021) and, in particular, using art to support reflection (Derry, 2005) and wellbeing (Bloem et al., 2018). It also draws on, and is underpinned by, the experiences of a diverse project team with unique experience working in a transdisciplinary way at the intersection of healthcare, education, and art. For example, one of the project leads is a lecturer, poet, and former palliative care specialist who teaches a university-level nursing module in which students both study and produce art in order to examine the human element of healthcare (University of Exeter Arts & Culture, 2023). Students’ enthusiasm about this module is what initially drew the project team together and prompted them to consider whether and how creative activities might have a place outside the classroom, in real-world clinical settings.

Implementing the intervention

Exploratory conversations with local professionals (based at the Hospiscare in Exeter, Devon, UK) revealed that palliative care practitioners were at a breaking point. In the wake of COVID-19, they reported staff shortages, dramatic increases in the number of patient referrals, higher patient turnover, and more traumatic circumstances surrounding patient deaths. Simultaneously, they shared how there were fewer clinical supervisions and other opportunities to reflect and debrief. As a result, rates of stress and burnout were incredibly high. Artistic activities (e.g., collage, poetry writing, drawing, working with clay) were identified as a potential means of addressing this – for example, by injecting mindful breaks into the working day, as well as supporting contemplation and offering a means for staff to reconnect with, and provide advice and reassurance to, each other.

Over a series of workshops, we brought together palliative care staff, nursing students, educators, and artists to explore and trial different creative activities (delivered both individually and as a curriculum incorporating multiple approaches). The sessions ranged in length from 30 minutes to three hours; some focused on a single artistic technique, while others incorporated multiple media; each was facilitated by an experienced creative who had tailored their plans to suit the professional needs and (budding) artistic abilities of healthcare workers. Participants were consistently enthusiastic, reporting that the workshops were ‘grounding’ and ‘restorative’.

The research team has worked with our creative collaborators and workshop participants to generate a list of activities deemed most useful in this context, produced guidance to support their delivery, and created a set of key considerations (needs, constraints) that can be used to identify which activities may be most appropriate for a given purpose, audience, or location. Perhaps even more importantly, our collaboration has also demonstrated the power of community-led, co-produced solutions to healthcare problems.

Coda: What might creativity achieve? A poem by Marie Clancy

What might we hear if creativity could sing?

If only her voice could show us heaven,

Angels in joyful repose as notes lift and show us a life beyond.

 

What might creativity do if she could allow reflection, expression, and the release of every emotion?

If she could capture experiences, like balloons on string, offering them freely to those in need.

 

What might we hear if creativity could shine her light upon colours so beautiful and diverse our soul is touched, broken open to a world of imagination still awaiting us, like fresh virgin snow.

 

What might we hear if creativity could offer us solace in the dark early hours or when the fear of death creeps over us and threatens to take our breath away,

What if that peace was within our reach?

 

What might creativity do if she could solve problems?

If she could inspire minds, stir hearts, and help those to the left see those on the right, as if through the clearing of a shadows thin mist.

 

What might creativity achieve if only she could still worry, focus attention, and calm the busy racing pulse of society?

 

What might creativity teach us if only we listened and whispered

Show me…

References

Bloem, Bastiaan R., Pfeijffer, Ilja L., and Krack, Paul. (2018). Art for better health and wellbeing. BMJ, 363:k5353.

Couper, K., et al. (2022). The impact of COVID-19 on the wellbeing of the UK nursing and midwifery workforce during the first pandemic wave: a longitudinal survey study. International Journal of Nursing Studies, 127, 104155.

Derry, Catherine. (2005). Drawings as a research tool for self-study: an embodied method of exploring memories of childhood bullying. In Just who do we think we are? Methodologies for self study in education (Mitchell, Claudia, O’Reilly-Scanlon, Kathleen, and Weber, Sandra, eds). Routledge.

Maben, J., et al. (2022). ‘You can’t walk through water without getting wet’ UK nurses’ distress and psychological health needs during the Covid-19 pandemic: a longitudinal interview study. International Journal of Nursing Studies, 131, 104242.

Scott, Curie. (2021). Drawing (Arts for Health series). Emerald Publishing Limited.

University of Exeter Arts and Culture. (2023). Accessed on 14 December 2023. https://www.artsandcultureexeter.co.uk/news/new-exhibition-explores-the-art-and-history-of-nursing

Watts, T., et al. (2023). Registered nurses’ and nursing students’ perspectives on moral distress and its effects: a mixed-methods systematic review and thematic synthesis. Nursing Open, 10(9), 6014-6032.

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